AB1413 SURVEY ON THE PRESCRIPTION OF GENERAL CORTICOSTEROID THERAPY BY MOROCCAN RHEUMATOLOGISTS IN RHEUMATOID ARTHRITIS
Authors: N. Jaouad, I. El Binoune, B. Amine, S. Rostom, R. Bahiri
Journal: Annals of the Rheumatic Diseases (2022)

Background The prescription of glucocorticoids at the diagnosis of rheumatoid arthritis (RA) is no longer systematically recommended because of the difficulty of withdrawal and the occurrence of adverse effects. The expert groups currently insist on a short duration of corticosteroids to obtain a low cumulative dose (1, 2). The real-life applicability of the current recommendations may be difficult to achieve (3). Objectives Moroccan rheumatologists were interviewed about their experiences on prescription of general corticosteroid therapy during the diagnosis of RA. Methods We conducted a descriptive cross-sectional study of practice conducted with the Moroccan rheumatologists belonging to public and private sectors according to a questionnaire established on a declarative and anonymous mode. The questionnaire was validated by a committee of experts before submitting them to rheumatologists and consisted of 24 single or multiple-choice questions. These questions were divided into 5 items: general data (3 questions), initiation of corticosteroid therapy at diagnosis (7 questions), withdrawal modalities and problems of withdrawal (8 questions), self-medication and patient information (6 questions). The elaboration of the questionnaire was done in “Google Forms” then the collected data were analyzed with the Microsoft office software Excel 2013. Results A total of 100 Moroccan rheumatologists responded to the questionnaire. In the initial treatment of RA, 14% of the rheumatologists reported starting corticosteroid therapy in all patients, 41% in two-thirds of their patients, 23% in one-third, 20% in half and 2% in none. The initial oral dose of prednisone or equivalent was 7.5 to 10 mg/day for 52% of rheumatologists and between 5 and 7.5 mg/day for 38%. Flare-up of activity and accompanying conventional treatment were the two first indications for initiation of corticosteroid therapy. 46% of rheumatologists considered weaning after 3 to 6 months of treatment, 26% between 6 months and one year, 23% in less than 3 months and 5% in more than one year. 35% achieve withdrawal in two thirds of their patients. The main problems encountered during withdrawal are self-medication and rebound of the disease. 96% of rheumatologists were in favour of introducing therapeutic education sessions using different tools adapted to the context of the patient and the disease. Conclusion The prescription of corticosteroids in RA must be based on the evaluation of the risk-benefit balance. A collaboration between rheumatologist and patient is necessary to prevent the risk of toxicity of corticosteroids and to achieve the goal of withdrawing them. References [1]Josef S Smolen, Robert B M Landewé, Johannes W J Bijlsma et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):685-699. [2]Liana Fraenkel, Joan M. Bathon, Bryant R. England et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2021 Jul;73(7):1108-112 [3]Bogdan Batko,Krzysztof Batko, Marcin Krzanowski, and Zbigniew Żuber. Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. J Clin Med. 2019 Sep; 8(9): 1416. Disclosure of Interests None declared